1356484703 NPI number — HARGRODER MEDICAL, INC.

Table of content: (NPI 1356484703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356484703 NPI number — HARGRODER MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARGRODER MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356484703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURCH POINT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70525-0407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-684-5232
Provider Business Mailing Address Fax Number:
337-684-3434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 HIGHWAY 190 STE X
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70535-5129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-580-7544
Provider Business Practice Location Address Fax Number:
337-580-7621
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARGRODER
Authorized Official First Name:
TY
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
337-684-5232

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  020601 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1038458 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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